Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207P00000X | Emergency Physician | 036112847 | IL |
Y | 207RC0200X | Critical Care Medicine | 036-112847 | IL |
N | 207RP1001X | Pulmonary Disease | 036-112847 | IL |
NPI | 1003955618 |
---|---|
Provider Name | John A Shanley |
First Address | Brentwood, TN 37027-5339 |
Second Address | Arlington Heights, IL 60005-2349 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/02/2007 |
Last Update Date | 07/05/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
036112847 | (05) | IL |